NTOX-11. DISEASE OUTCOMES, TOXICITY PROFILES, AND HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH RECURRENT GLIOBLASTOMA RECEIVING INTRA-ARTERIAL CARBOPLATIN SALVAGE THERAPY

Abstract

INTRODUCTION: Glioblastoma (GBM) remains the most aggressive entity of primary brain tumors with a reported median survival of 14.6 months, despite maximal therapy. While the paradigm developed by Stupp et. al. is considered to be standard care treatment for primary GBM, there is no consensus regarding optimal treatment regimens at disease relapse. We describe here our experience with local disease control, overall survival (OS), toxicity profiles, and patient reported Health-Related Quality of Life (HR-QOL) of an intra-arterial (IA) carboplatin-based treatment for recurrent high-grade gliomas in combination with intravenous bevacizumab. METHOD(S): Patients >=18 years-of-age with recurrent GBM were treated with 400 mg/m2IA carboplatin every 4 weeks and10 mg/kg bevacizumab every 2 weeks at Abbott Northwestern Hospital's neuro-oncology program. Patients were followed for treatment related adverse events, progression-free survival (PFS), and OS. HR-QOL scores were measured at specific time-points with EORTC QLQ-30 & BN-20 questionnaires. RESULT(S): Twenty-three patients with a median age of 52 (33-66) years were included in the final cohort. Median PFS was 7 (3-10) months and OS was 26 (16-36) months. Number of surgical resections (1 vs. >=2) were significantly associated with OS (p=0.02) and MGMT-promoter methylation associated with better prognosis (22 vs. 26 months). Headaches (n=10) were the most prevalent neurological complications. Seven patients had focal seizures and 3 had generalized seizures. Nausea was reported by 15 patients and fatigue by 16 patients. Grade 4 thrombocytopenia was observed in 4 patients. Three patients had strokes, 2 of which were deemed related to the IA procedure. Prior to treatment failure, longitudinal global-QOL was maintained in most of the patients. CONCLUSION(S): IA carboplatin with avastin provides an adequate option for salvage therapy in GBM with encouraging survival outcomes in a carefully selected group of patients. Until disease progression, no significant unfavorable effects on HR-QOL was noted with this therapy.